Provider Demographics
NPI:1770569733
Name:OTERO-BERMUDEZ, JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:OTERO-BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503 48
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4165
Practice Address - Country:US
Practice Address - Phone:407-956-1920
Practice Address - Fax:407-483-5844
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5545208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA09147946OtherDEA
25867Medicare ID - Type Unspecified
E43272Medicare UPIN